Medicine Shortages and Supply Chain Disruption

Despite the fact that COVID-19 is still in the pandemic stage (according to the WHO), containment measures such as testing and isolation are being dropped in various countries. While many countries worldwide are declaring that the COVID-pandemic is now transitioning towards an endemic stage, the long-term effects of the pandemic on national and international healthcare systems are still evident.

Healthcare systems are facing a number of challenges, which are in part caused by or made worse by the pandemic, such as healthcare workforce shortages, long waiting lists for patients, supply chain disruptions, and medical drug shortages. Some of these problems are related to processes that have been ongoing for years or even decades, such as the increased workload of medical personnel, aging populations, and the increase in incidence of chronic and complex diseases.

Supply chain disruptions that started during the pandemic were seen again because of the war in Ukraine and the following energy crisis. The global economic situation and inflation further complicated supply chains. In this blog piece, we highlight the effect of supply chain disruptions on the drug shortages that are currently experienced in Europe, the USA, and the UK.

Medicine shortages world-wide

The EU is experiencing major medicine shortages of hundreds of drugs. The European Medicines Agency (EMA) keeps track of drug shortages in its member countries via national registries that list which human medicines are either currently or soon to be in shortage. In the USA, the FDA keeps a similar registry to ensure challenges in the supply chain are noted early. Medicines that are harder to get by at the moment are some life saving medicines, such as Metylase (tenecteplase), which is used in the hours after a heart attack, and Pazenir (paclitaxel) which is used to treat various cancers. These medicines are in higher demand than the manufacturer can currently produce. The set-up of more Metylase manufacturing capacity is expected to solve the supply for this medicine by 2024. The surge in respiratory infections (such as the RS-virus) has led to a shortage of the wide range antibiotic amoxicillin and pediatric paracetamol/aminocetaphen.

Another drug that is in short supply is Ozempic (semaglutide), which is meant to treat diabetes type 2 patients, but is now popular because of its potential weight loss stimulating capacities. Also, unforeseen events, such as quality impairments, can temporarily affect the supply route of a drug which is the case for various types of Insuman (human insulin). And further, some drug manufacturers experience so many challenges in the supply chain that the entire production may be terminated. This is the case for Natpar (parathyroid hormone) that is used as an add-on treatment for patients with hypoparathyroidism and will be discontinued globally by the end of 2024.

Having these registries and overviews of shortages is essential for the planning of the rightful course of action for patient treatment. Most national healthcare agencies first suggest switching to an alternative drug with the same active ingredient, albeit in a different dose or administration form, secondly they suggest sourcing the drug from another country, and only as a third option should the drug be ransomed and distributed to a select group of patients.

Taking control

Various steps can be followed to take more control before and during medicine shortages. The monitoring of changing demands in the healthcare sector is essential to adjust the supply or prepare the supply chain for changes in the short-term. An example of this is the monitoring of the so-called tripledemic, the occurrence of outbreaks of influenza, COVID-19 and RSV (respiratory syncytial virus). Virus surveillance is necessary to predict where and when the largest disease burden is likely to take place. Having these insights could optimize the distribution of scarce medicines, such as pediatric paracetamol, and limit the chance of hospital emergency departments being overwhelmed.

Another tool in the arsenal to tackle medicine shortages is the use of digital healthcare. Keeping track of drug stocks in hospitals, pharmacies, and at patients’ homes is essential to be able to intervene adequately in patients who are at risk of running out of medicines. If a drug is not available, usually the first step is to switch the drug brand or dosage of the drug. Using telemedicine and remote monitoring systems helps to closely follow these patients through their medicine change, which in turn is necessary to mitigate any unwanted effects.

Some countries are also trying to introduce legislation to prevent national medicine shortages. The EU health commissioner has announced that the EU is taking plans to change pharmaceutical laws so that companies will have a stronger obligation to secure the supply chain for medicines, to keep a larger stock of essential medicines, and to make notifications of potential shortages known earlier. Additionally, members of the EU are asking for regulatory flexibility to exempt drugs with different labeling or packaging. However, this legislation might be in contradiction with legislation that aims to lower prices of medicines within the EU, as getting medicines cheaper sometimes also means taking a few steps back in the priority list of pharmaceutical contracts.

At the same time, EU countries are also calling for more medicine production within the EU, so as to have better oversight of the supply chain in case of international events and emergencies. This call for more internal medicine production was highlighted during the COVID-19 pandemic and received further attention during the last months of medicine shortages.

Role of a sound procurement process

Although it is impossible to precisely predict the future, more countries are demanding some level of robustness and event-proofness in the supply chain of essential medicines, as the COVID-19 pandemic showed that supply chains can become fragile. Matching the right supplier to the right buyer ensures that the specific supply chain can be discussed adequately and can be fine tuned to different situations. Vamstar is an AI-based platform that aims to bring more efficiency and transparency to the procurement process, so that both buyers and sellers can engage in trusted partnerships. Value-based procurement plays an increasingly important role in tendering and helps to select for various non-price based factors that can be essential for ensuring a proper supply chain. We strongly believe that Vamstar can play a role in overcoming these challenges.

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